5. PRINSIP UMUM BEDAH PERIODONTAL.ppt

7/30/2019 5. PRINSIP UMUM BEDAH PERIODONTAL.ppt

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PRINSIP UMUM BEDAH

PERIODONTAL


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1. Persiapan

2. P r e m e d i k a s i

3. Merokok4. Informed consent (persetujuan tindakan medis)

5. Pemberian sedasi atau anestesia

6. Penanggulangan jaringan

7. Pemberian antihemostasis

8. Scaling dan root planing

9. Pemberian pack periodontal (dressing)

OUTLINE


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REEVALUASI SETELAH PERAWATAN FASE I

Menghilangkan semua iritan yg berperan thdpterjadinya keradangan periodontal.

Fase reevaluasi meliputi probing dan pemeriksaan

kembali semua indikator sebelumnya

1. PERSIAPAN PASIEN


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1. PERSIAPAN PASIEN

These procedures

(1) eliminate some lesions entirely;

(2) render the tissues more firm and consistent, thus permitting

a more accurate and delicate surgery; and(3) acquaint the patient with the office and the operator and

assistants, thereby reducing the patient's apprehension and

fear


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DENTAL EQUIPMENTS

The operator, all assistants, and office

personnel should be trained to handle all the

possible emergencies that may arise. Drugs

and equipment for emergency use should be

readily available at all times.

BASIC LIFE SUPPORT


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Preventing transmission of infection

Universal Precaution

Sterilization

Disposal


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Pemberian obat obatan sebelum tindakan operasi

sehubungan dng penyakit umum yg dideritanya atau krn

rasa takutnya.

Pemberian antibiotika utk profilaksis, khususnya pasien

dng penyakit jantung, diabetes dan penyakit tertentu

lainnya.

Antibiotika diberikan pada kasus yang membutuhkan

regenerasi untuk memperbesar kemungkinan terjadinya

new attachment.

Pd setiap kasus, resiko akibat pemberian antibiotika hrs

dipertimbangkan efek samping dan manfaatnya.

2. P R E M E D I K A S I


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Obat lain yang biasa diberikan adalah

NSAIDs (Ibuprofen, Methampyron & Diazepam, Asam

Mefenamat)

Kortikosteroid (Dexamethasone, Methyl Prednisolon)

Obat kumur (Chlorhexidine, Chlorine Dioxine, Hyaluronic

Acid, Aloe Vera, Air garam hangat)

2. P R E M E D I K A S I


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Pasien disarankan utk berhenti merokok atau tidak

merokok 3 4 minggu setelah perawatan krn dpt

menyebabkan iritasi atau menghambat penyembuhan

3. MEROKOK


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4. INFORMED CONSENT

Pd kunjungan pertama pasien hrs diberitahu tentang

diagnosa, berbagai kemungkinan perawatan serta

perkiraan hasilnya.

Juga hal-hal yang diperkirakan kelebihan serta

kekurangan dr masing-masing prosedur perawatan

secara lisan maupun tulisan kemudian

Pasien harus menanda tangani persetujuan pelaksanaan

prosedur bedah pada suatu formulir persetujuan.


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Utk mengurangi kecemasan perlu diberi obat penenangatau obat sedasi utk mengurangi rasa takut dan

kecemasan. Dpt diberikan secara inhalasi, oral,

intramuskular, dan intravenous. Contoh : benzodiazepine.

Utk mengurangi rasa sakit saat operasi maka perlu

pemberian anastesi lokal sebelumnya

5. SEDASI DAN ANESTESIA


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SEDASI

2. Inhalasi

Nitrous Oxide

3. IM/IV

Bezodiazepine (Midazolam)

1. Per Oral


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1. Operate gently and carefully.

2. Observe the patient at all times.

3. Be certain the instruments are sharp.

6. TISSUE MANAGEMENT


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Umumnya aspirasi cukup membantu menyediakan lapanganpandang yang bersih. Penggunaan vasokonstriktor padaanestesi juga mengurangi perdarahan

Kompres air es steril bisa dilakukan.

Utk menghambat ataupun menstabilkan flow perdarahandpt dipergunakan beberapa bahan hemostatik ygabsorbable a.l : Gelfoam (Absorbable gelatin sponge ),Oxycel (Oxidized cellulose).

Ligasi vessel bila mengenai pembuluh darah

7. HEMOSTASIS


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Walaupun scaling dan root planing telah dilakukan pada

perawatan fase I. Semua permukaan akar yg terbuka pd

waktu prosedur bedah hrs dieksplorasi dan di root planingseperlunya sebagai bagian dr prosedur bedah.

Terutama pada daerah yg aksesnya sukar / jelek, seperti

daerah furkasi atau poket yg dalam, sering didapati daerah

daerah yang kasar bahkan kalkulus yang tidak terdeteksi pd

waktu penyiapan permukaan gigi.

8. SCALING & ROOT PLANING


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9. PERIODONTAL PACK


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PURPOSES OF PERIODONTAL PACK

Provide mechanical protection for the surgical wound and

therefore facilitate healing

Helps prevent post operative bleeding by keeping the initial

clot in place

Supports mobile teeth during healing

Mechanically maintains post-surgical position of the flaps

Helps in shaping or molding the newly formed tissue

Provide patient comfort by isolating area from externalirritations or injuries


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CHARACTERICS OF PERIODONTAL PACK

Nontoxic or nonirritating to the tissue

Conveniently prepared, placed and removed with

minimal discomfort to patient

Should maintain adhesion to itself and to the teeth,

kept in place mechanically by interlocking ininterdentalspaces


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The clinical effects of a periodontaldressing after modifiedWidman flap surgery were studied. A total of thirty surgicalsites in 13 patients were included in the study. Half of thesites were not covered by a periodontaldressing while theother half were. All patients were instructed in oral hygieneprocedures and received rubber cup prophylaxes and flossingat 1 week, 2 weeks, 1 month and 2 months postoperatively.At the conclusion of the study, a questionnaire wasadministered to each patient. No significant differences werefound between dressed and undressed segments regardingchanges in clinical attachment levels, pocket depth, or gingival

inflammation. The omission of a dressing did not result in agreater incidence of discomfort. More patients statedpreference for no dressing.

Comparison of results following modified Widman flap surgery with and without surgical dressing.

(eng) By: Allen DR, Caffesse RG, Journal Of Periodontology [J Periodontol], ISSN: 0022-3492, 1983 Aug; Vol. 54 (8), pp. 470-5; PMID:

6352896;
http://web.ebscohost.com/ehost/viewarticle?data=dGJyMPPp44rp2/dV0+njisfk5Ie46a9IsKa2TK+k63nn5Kx95uXxjOvb4li0pbBNraiuSbCWr0m4p7NSsKmeWcuc8orf5PF54ernh+zf4lWrqLROsKu2TLSupITf5OVV4+SkfOCz64bmnPJ55bO/ZqTX7FW0qbNKtq+0PuTl8IXf6rt+8+LqjOPu8gAA&hid=7http://web.ebscohost.com/ehost/viewarticle?data=dGJyMPPp44rp2/dV0+njisfk5Ie46a9IsKa2TK+k63nn5Kx95uXxjOvb4li0pbBNraiuSbCWr0m4p7NSsKmeWcuc8orf5PF54ernh+zf4lWrqLROsKu2TLSupITf5OVV4+SkfOCz64bmnPJ55bO/ZqTX7FW0qbNKtq+0PuTl8IXf6rt+8+LqjOPu8gAA&hid=7http://web.ebscohost.com/ehost/viewarticle?data=dGJyMPPp44rp2/dV0+njisfk5Ie46a9IsKa2TK+k63nn5Kx95uXxjOvb4li0pbBNraiuSbCWr0m4p7NSsKmeWcuc8orf5PF54ernh+zf4lWrqLROsKu2TLSupITf5OVV4+SkfOCz64bmnPJ55bO/ZqTX7FW0qbNKtq+0PuTl8IXf6rt+8+LqjOPu8gAA&hid=7http://web.ebscohost.com/ehost/viewarticle?data=dGJyMPPp44rp2/dV0+njisfk5Ie46a9IsKa2TK+k63nn5Kx95uXxjOvb4li0pbBNraiuSbCWr0m4p7NSsKmeWcuc8orf5PF54ernh+zf4lWrqLROsKu2TLSupITf5OVV4+SkfOCz64bmnPJ55bO/ZqTX7FW0qbNKtq+0PuTl8IXf6rt+8+LqjOPu8gAA&hid=7http://web.ebscohost.com/ehost/viewarticle?data=dGJyMPPp44rp2/dV0+njisfk5Ie46a9IsKa2TK+k63nn5Kx95uXxjOvb4li0pbBNraiuSbCWr0m4p7NSsKmeWcuc8orf5PF54ernh+zf4lWrqLROsKu2TLSupITf5OVV4+SkfOCz64bmnPJ55bO/ZqTX7FW0qbNKtq+0PuTl8IXf6rt+8+LqjOPu8gAA&hid=7http://web.ebscohost.com/ehost/viewarticle?data=dGJyMPPp44rp2/dV0+njisfk5Ie46a9IsKa2TK+k63nn5Kx95uXxjOvb4li0pbBNraiuSbCWr0m4p7NSsKmeWcuc8orf5PF54ernh+zf4lWrqLROsKu2TLSupITf5OVV4+SkfOCz64bmnPJ55bO/ZqTX7FW0qbNKtq+0PuTl8IXf6rt+8+LqjOPu8gAA&hid=7http://web.ebscohost.com/ehost/viewarticle?data=dGJyMPPp44rp2/dV0+njisfk5Ie46a9IsKa2TK+k63nn5Kx95uXxjOvb4li0pbBNraiuSbCWr0m4p7NSsKmeWcuc8orf5PF54ernh+zf4lWrqLROsKu2TLSupITf5OVV4+SkfOCz64bmnPJ55bO/ZqTX7FW0qbNKtq+0PuTl8IXf6rt+8+LqjOPu8gAA&hid=7


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Wound dressing has a positive effect on clinical long-term results usinga two-step non-surgical procedure.

Moreover, removing the dressing after 78 days leads to

clearly better results than removing it earlier.

Sigusch BW, Pfitzner A, Nietzsch T, Glockmann E. Periodontal dressing (Vocopacs)

influences outcomes in a two-step treatment procedure. J Clin Periodontol 2005; 32:401405.


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MACAM MACAM PACK :

PACK ZINC OXIDE - EUGENOL

NON EUGENOL PACK


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PACK ZINC OXIDE EUGENOL

Didasarkan pada reaksi dr zinc oxide eugenol.

Bahan tambahan lainnya adalah asbestos sbg bahan pelekat

dan pengisi serta tanic acid.

Asbestos dpt menyebabkan penyakit paru dan karsinogenik

serta tanic acid menyebabkan kerusakan hati

Eugenol dapat meningkatkan reaksi allargi yg

mengakibatkan warna kemerahan pd daerah yg dikenai danrasa nyeri seperti terbakar pada boberapa ponderita.


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Non eugenol pack

Dressing ini tidak mengandung asbestos atau eugenol.

Reaksi dari metalic oxide dan asam lemak merupakan dasar

untuk Coe-Pack, yg sering dipakai di Amerika Serikat. CoePack

tersedia dlm dua tube yang dicampur sebelum digunakan

sampai dicapai warna yang merata. Jari harus diminyaki dng

vaselin. Coe-Pack dpt dibentuk antara 35 menit setelah diadukdan tetap masih dpt dipergunakan selama 15 - 2O menit.


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PACK NON-EUGANOL LAINNYA MENCAKUP :

1. Cyanocrylates.

2. Zinc oxide dan Glycol alkohol

3. Tissue Conditioner


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Bahan antibakteri

Improved healing and patient comfort with less odor and taste

have been obtained by incorporating antibiotics in the pack.

Bacitracin, oxytetracycline (Terramycin), neomycin, andnitrofurazone have been tried, but all may produce

hypersensitivity reactions. The emergence of resistant

organisms and opportunistic infection has been reported.

Incorporation of tetracycline powder in Coe-Pak is generallyrecommended, particularly when long and traumatic surgeries

are performed.


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CARA PEMASANGAN pack

Pack zinc oxide berupa powder dicampur dng liquideugenol atau non eugenol di atas kertas berlilin dngspatel sampai mengental.

Utk Coe pack terdiri dari 2 pasta yg dicampur. Campurantsb kemudian digulung sampai panjang sesuai dngukuran daerah operasi dan dipasang pd sisi bukal dan

lingual dan harus menutupi gingiva, jangan sampai kemukosa / dasar mulut ataupun he oklusal. Usahakan packmelekat minimal

CARA PASANG PACK


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CARA PASANG PACK


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Instruksi post op

Usahakan pack jangan sampai terlepas krn bahan tsb sebagaipenutup luka setelah operasi

Bila ada rasa tidak enak boleh minum obat analgesik

Tiga jam setelah operasi hindari makan / minum panas supaya packdapat mengeras.

Hindari makan pedas atau rasa asam dan minuman yg mengandungalkohol krn dpt meninmbulkan rasa nyeri

Jangan merokok

Satu hari kemudian baru diperbolehkan kumur-kumur dng obatkumur

Bila dlm 1 hari kemudian pack lepas, diharapkan kembali utkpemasangan ulang, bila tidak lepas kontrol 7 hari kemudian.


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FINDINGS ON PACKS

If a gingivectomyhas been performed, the cut surface iscovered with a friable meshwork of new epithelium, whichshould not be disturbed.

After aflap operation, the areas corresponding to the

incisions are epithelialized but may bleed readily whentouched; they should not be disturbed. Pockets should notbe probed.

The facial and lingual mucosa may be covered with a

grayish yellow or white granular layer of food debris thathas seeped under the pack.

Fragments of calculus delay healing.


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TERIMA KASIH

5. PRINSIP UMUM BEDAH PERIODONTAL.ppt

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